Spinal metastases

　　Spinal metastatic tumors are the most common tumors in the spine. At the same time, the spine is the most common site of bone metastasis for tumors. Up to 40% to 80% of patients who die of tumors have bone metastasis. More than 20% of patients with spinal metastasis have neurological damage. 75% of bone metastases occur in patients with breast cancer, lung cancer, renal cancer, prostate cancer, thyroid cancer, and multiple myeloma. The main cause is the stimulation of various tumor factors leading to spinal metastasis.

　　The treatment of spinal metastases often requires surgery, and common complications may occur after surgery:

　　One, Lungs

　　1, Pneumonia: It is related to tracheal intubation anesthesia, postoperative bed rest, and respiratory restriction after thoracolumbar surgery, and is often atelectasis pneumonia.

　　2, Hemothorax: It can be caused by accidental injury to the pleura during extrapleural surgery without discovery, or by incomplete repair in a timely manner; it can also occur due to inadequate hemostasis, unobstructed drainage, or failure to place a closed chest drain.

　　二、心血管

　　1、心律失常：与术中对迷走神经、交感神经干牵拉或损伤，以及手术时间长、术中缺血时间长及合并肺部并发症等有关。原有心肌缺血者更易出现。

　　Two, cardiovascular

　　1. Arrhythmia: Related to traction or injury of the vagus nerve and sympathetic trunk during surgery, long operation time, prolonged ischemia during surgery, and complications of the respiratory system. Patients with pre-existing myocardial ischemia are more prone to arrhythmia.

　　What are the typical symptoms of spinal metastases

　　Pain is the most common complaint in patients with symptomatic spinal metastatic cancer, occurring in 83-95% of patients, several weeks or months earlier than other neurological symptoms. The earliest symptom is usually pain in the chest, back, or lumbar back at the level of the lesion, which is generally mild, intermittent, and often goes unnoticed. It gradually becomes persistent and severe with symptomatic treatment. 10% of cancer patients have spinal metastatic cancer-related pain as their first symptom. Patients with spinal metastatic cancer have three typical types of pain, including local pain, mechanical pain, and radicular pain. The pain the patient experiences may be one type or a combination of several types.

　　Imbalanced diet is an important cause of tumors. Therefore, it is recommended in daily life to pay attention to eating less of the following foods to prevent the occurrence of tumors.

　　1. Food with increased pollutants: Such as pesticides in vegetables and fruits, and harmful additives in food.

　　2. Fried food: Such as fried dough sticks, fried fish, etc., in the process of making such foods, not only can reduce the nutritional content of food, destroy vitamins A, B, C, etc., but also produce harmful substances with strong carcinogenic effects.

　　3. High-fat diet: Investigations show that high intake of fats, meats, and sugars is associated with a higher incidence of cancer and other diseases.

　　4. Moldy food: Foods such as moldy peanuts, melons, or corn contain a large amount of aflatoxin, which can induce liver cancer.

　　5. Overnight vegetables: Containing a large amount of nitrites, they can combine with protein decomposition products in the stomach to form nitrosamines, which are easy to cause gastric and intestinal cancer.

　　Spinal metastases are commonly seen in various types of tumor metastasis. Generally, the following examinations are required for this disease:

　　1. X-ray Films

　　X-rays have long been used as the primary evaluation method for patients with newly onset symptoms related to the spine.

　　2. SPECT (Single Photon Emission Computed Tomography)

　　SPECT is a more advanced method than radionuclide bone scanning.

　　3. Magnetic Resonance Imaging

　　Magnetic resonance imaging (MRI) is considered the gold standard imaging equipment for evaluating spinal metastatic cancer. In terms of detecting spinal lesions, MRI imaging is more sensitive than conventional X-ray films, CT, and radionuclide scans.

　　4. Conventional digital subtraction angiography

　　Angiography is an important tool for evaluating spinal metastatic cancer.

　　5. Percutaneous biopsy

　　The advancement of imaging technology has improved the detection of cancerous lesions, but diagnosis usually still requires biopsy of the spinal lesion.

　　To enable a faster recovery from the disease, it is recommended that patients pay attention to the following dietary principles:

　　1. Eat more sulfur-rich foods, such as asparagus, eggs, garlic, and onions. Because the repair and reconstruction of bones, cartilage, and connective tissues require sulfur as a raw material, and sulfur also helps in the absorption of calcium.

　　2. Eat more histidine-rich foods, such as rice, wheat, and rye. Histidine is beneficial for clearing excess metals in the body. Consume more foods rich in carotenoids, flavonoids, vitamins, and sulfur compounds.

　　3. Eating fresh pineapples regularly can reduce infections in the affected area.

　　4. Ensure that you eat some vitamin-rich foods every day, such as flaxseeds, rice bran, and oat bran.

　　The treatment of spinal metastatic cancer often involves multiple therapies and a large number of specialists, such as surgeons (neurosurgery, orthopedics, oncological surgery), medical oncologists, pain specialists, interventional radiologists, and rehabilitation specialists. Radical treatment is usually impossible, so the goal of treatment is to preserve neurological function, relieve pain, and stabilize the spine. Surgical treatment can successfully achieve these goals, but patients vary greatly in age, tumor burden, life expectancy, and physical condition, which greatly affects the choice of treatment methods.

　　1. Radiotherapy

　　Patients with pain, no progressive neurological impairment, and no instability are suitable for medication and radiation therapy. Radiation therapy is very effective in relieving pain. Radiation therapy can also be used for neurological damage caused by metastases sensitive to radiation. When combined with surgical treatment is needed, the timing of radiotherapy needs to be very cautious. Animal experimental results show that radiotherapy should start at least 3 weeks after surgery to promote the smooth fusion. Many authors also indicate that the incidence of complications after preoperative and immediate postoperative radiotherapy is high. These complications include wound dehiscence, wound infection, and failure of internal fixation.

　　2. Disease Assessment

　　Tokuhashi has developed a scoring system for patients with spinal metastatic tumors to guide treatment based on different prognoses. The scoring system consists of 6 parameters, including the patient's overall condition, the number of extraspinal bone metastases, the number of vertebral bone metastases, the condition of important visceral organ metastases, the primary tumor site, and the condition of spinal cord damage. Each parameter is scored from 0 to 3 points. Patients with a total score of 9 or higher are suitable for surgical resection, while those with a score below 5 are suitable for palliative treatment. The results of the 1997 study showed that this scoring system is a very good prognostic assessment tool. The study found that the average survival time of patients with a score of 7 or less was only 5.3 months, while those with a score of 8 or higher had an average survival time of 23.6 months. Most authors believe that patients with an average survival expectation of about 3 months are not suitable for aggressive surgical intervention.

　　3. Treatment of Neurological Damage

　　The treatment of patients with neurological damage caused by metastatic tumors is very challenging. The timing of neurological damage is very important. Acute onset and complete paralysis or severe anterior cord syndrome have poor prognoses because they both involve spinal cord vascular involvement. Patients with progressive paralysis caused by epidural tumor compression have a better prognosis. Any patient with neurological damage should undergo a full spinal MRI scan to exclude multiple compressions. Studies show that more than one-third of patients with neurological damage have multiple lesions, and the treatment for such patients should not be too aggressive because their average survival time is quite short.

　　4. Surgical Methods

　　There has always been controversy about whether to perform surgery on patients with metastatic tumors and neurological damage, because some old studies show that the effect of surgery is not better than radiotherapy. The reason is that the surgical methods used in these studies are all simple laminectomy. As mentioned earlier, most metastatic tumors are located in the anterior structures, and only 10% of nerve compression injuries come from posterior tumor compression. Many studies clearly prove that the anterior tumor can be reliably operated on by anterior surgery with good results. Decompression by posterior approach at 360° or 270° can also achieve the purpose of full decompression, and it has better effect on maintaining spinal stability than simple anterior surgery. However, the disadvantages of posterior surgery are that the surgical trauma is greater than that of anterior surgery, and the postoperative complications are higher. In terms of histology, the average success rate of literature reports on radiotherapy alone is 73% (successful definition is maintaining or regaining walking function), and the salvage rate is about 30% (defined as patients regaining walking function). More recent studies show that the success rate can reach 85%, and the salvage rate can reach 60%. A recent study shows that the therapeutic effect of combined direct decompression and radiotherapy is better than radiotherapy alone. Both groups of patients received the same dose of hormones and the same dose of radiotherapy. The patients who received surgical treatment maintained walking and sphincter function for a significantly longer time than those who received radiotherapy alone. Additionally, 56% of the non-walking patients in the surgical group regained walking function, while only 19% in the radiotherapy group. As expected, there was no significant difference in survival time between the two groups of patients.